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32 Cards in this Set
- Front
- Back
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When to consider evaluating for secondary causes of HTN? (6)
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young age, no family history, no risk factors, rapid onset, abrupt change, endocrine abnormality
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Indications for rasburicase (being that it is more expensive) (2)
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high risk for tumor lysis syndrome or very high UA levels in chemo
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NOTE: Plain AXR has no role in
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the acute diagnosis of kidney stones.
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NOTE: There is no role for the routine measurement of
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EPO in CKD.
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How does GFR relate to creatinine?
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inversely proportional; 50% reduction in GFR = doubling of serum crea
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medications that block tubular secretion of creatinine (resulting in higher crea without change in GFR)
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TMP, cimetidine
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alternative marker of GFR that is less influenced by age, gender, muscle mass, and body weight compared with serum creatinine
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cystatin C
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high urinalysis pH
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strict vegetarians, distal RTA, urease-splitting organisms (Proteus and Pseudomonas)
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urine dipstick reads negative or trace for protein but shows increased positivity for protein by the SSA test
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consider multiple myeloma - presence of urine light chains or Ig not detected by urine dipstick
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at what serum glucose does glucosuria occur?
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180-200 mg/dL
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differential diagnosis for (+) ketones
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DKA, starvation / alcoholic ketoacidosis; salicylate toxicity, isopropyl alcohol poisoning
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ketones detected by urinalysis
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acetoacetate, not B-OH
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confirms myoglobinuria
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urine myoglobin levels
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when is nitrites (+)?
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GN UTI (Kleb, E. coli, Proteus, Pseudomonas)
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differentials for (+) urobilinogen in urinalysis
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hemolytic anemia or hepatic necrosis (NOT obstructive causes)
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differentials for (+) bilirubin in urinalsysi
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severe liver disease or obstructive jaundice
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sterile pyuria differentials
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M. tuberculosis, AIN, kidney stones, kidney transplant rejection
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common causes of AIN
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antibiotics, NSAIDs, PPI
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differentials for urine eosinophil (+) in urinalysis
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allergic reaction, atheroembolic disease, RPGN, small vessel vasculitis, UTI, prostatic disease, parasitic infections
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blood in urine: isomorphic RBCs
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tumor, stone or infection
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blood inurine: acanthocytes and RBC casts
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GN, severe interstitial nephritis, ATN
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casts in urinalysis
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hyaline casts - hypovolemia; pigmented granular (muddy brown) casts - tubular injury; RBC casts - GN; WBC casts - tubulointersitial inflammation of kidney, pyelonephritis
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urine crystal shapes
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envelope / dumbell / needle (calcium oxalate); prism, needle, star-like clumps (calcium phos); rhomboid / needle / rosette (uric acid); coffin lid (struvite / magnesium ammonium phos); hexagonal - cystine
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Nephrotic-range proteinuria
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protein–creatinine ratio greater than 3.5 mg/mg
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ADA recommendation: when to check urine albumin-crea ratio in DM?
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typ1DM x 5 years; all type 2 DM at time of diagnosis
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ADA definition of microalbuminuria
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urine albumin–creatinine ratio of 30 to 300 mg/g; two of three random samples over 6 months
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transient proteinuria differentials
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fever, rigorous exercise
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proteinuria increases during the day and decreases at night when the patient is recumbent
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orthostatic proteinuria
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diagnostic test for orthostatic proteinuria
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split urine collection
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imaging used in the evaluation of hematuria
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CT urography, MR urography, US, IVP
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which urinary tract imaging to choose in hematuria
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CT uro for high-risk patients with preserved GFR; MR uro when GFR 30-60; US in <40y/o with no RF for urologic malignancy; noncontrast abd CT if stones suspected; IVP no longer recommended
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hematuria ffd by negative evaluation of upper urinary tract, next step
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cystoscopy; assess for lower ureteral, bladder or urethral causes
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